title: Optimising outpatient efficiency - development of an innovative 'Did Not Attend' management approach.
abstract: OBJECTIVE
  To examine non-attendance [or Did Not Attend (DNA)] rates in a community mental health follow-up outpatient clinic and evaluate a pragmatic initiative to reduce non-attendance.
  
  
  METHODS
  Clinical audit of attendance across two community psychiatry outpatient clinics was used to establish DNA rates at baseline. Both clinics sought to reduce the DNA rate and were made aware of the outcome of the first cycle of audit. Clinic A (intervention clinic) introduced an innovative new management approach aimed at reducing DNAs, whilst Clinic B (control clinic) introduced no further systematic measures. The clinics were then re-audited to establish the impact of the changes.
  
  
  RESULTS
  We found that the introduction of the new management approach in Clinic A was associated with reduced numbers of service users failing to attend for a clinic appointment (n = 1134, relative risk 0.59, 95% Confidence Interval (C.I.) 0.44-0.77, NNT = 12). No such difference was identified in Clinic B.
  
  
  CONCLUSIONS
  Intervention to reduce the DNA rate is realistically achievable with minimal effort and modest additional cost. The actions required of clinicians are practicable, and can have a direct impact without large-scale organisational change.
authors.affiliation: Hertfordshire Partnership NHS Foundation Trust, St. Albans , Hertfordshire , UK.
authors.forename: Billy
authors.initials: B
authors.lastname: Boland
authors.forename: Frances
authors.initials: F
authors.lastname: Burnett
mesh_terms: D003155:Community Mental Health Centers; D006297:Health Services Accessibility; D006801:Humans; D010045:Outpatients / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data
keywords: Did Not Attend; Outpatient; attendance; community psychiatry; supervision